Cellulitis caused by Streptococcus pyogenes at the Bacille Calmette-Guérin vaccination site: A case report

Recently, the number of reports on skin manifestations, including tuberculids, developing as adverse reactions to the Bacille Calmette-Guérin (BCG) vaccine has increased in Japan. We encountered a case in which an infant developed cellulitis at the vaccination site. The patient was a girl who received the BCG vaccine 5 months after birth. Two months after vaccination, she developed a fever of 39ºC, and redness and swelling spread to the entire left upper arm. After being treated with oral cefditoren pivoxil, she was referred to our hospital and received treatment with intravenous sulbactam/ampicillin. Streptococcus pyogenes was detected in a culture of the vaccination scars, and the reaction was very likely caused by pathogenic bacteria. There has been no previous report on a patient developing cellulitis following BCG vaccination caused by S. pyogenes at the vaccination site. Here, we describe such a case with a literature review

Home-based subcutaneous immunoglobulin after switch from intravenous immunoglobulin improved quality of life in pediatric patient with common variable immunodeficiency: A case report

　Common variable immunodeficiency (CVID) is one of the primary immunodeficiency. Regular immunoglobulin G (IgG) replacement therapy is often performed for patients with CVID.　We experienced a patient who was hospitalized in our hospital for repeated pneumonia and diagnosed CVID at the age of 10 years. He had often been absent from school due to infectious diseases. We were administered intravenous IgG (IVIG) two times and his serum level of IgG became over 1,000 mg/dL. Afterward, he was affected the hand-foot-and-mouth disease one week after discharge. At that time, his IgG level decreased to 751 mg/dL. To maintain stable IgG trough levels, we introduced subcutaneous IgG (SCIG). Since then, his IgG levels remained around 1,000 mg/dL, he has lived without suffering from infectious diseases.　There are some reports that IVIG and SCIG were compared and SCIG was able to obtain a stable IgG trough levels to prevent infection. In addition, because our patient is a mother and child family, it was difficult to visit the outpatient department frequently, so it was desirable to infuse at home.　We experienced a patient who had a stable trough levels with SCIG and improved quality of life, so we report this case with literature reviews

Reactive oxygen metabolites as a biomarker of congenital heart disease in children

　Brain natriuretic peptide (BNP), as a hematological biomarker, has been widely used in congenital heart disease (CHD). However, its sensitivity and specificity vary depending on age and pathological condition. In the present study, we assessed whether reactive oxygen metabolites (ROMs) and biological antioxidant potential (BAP), as oxidative stress indicators, could be new biomarkers in CHD.　Forty-two patients diagnosed with CHD were enrolled in this study. The levels of ROMs, BAP, BNP, cardiac muscle creatinine kinase, and heart-type fatty acid-binding protein were measured using the findings of echocardiography. The ROM and BNP levels were significantly higher than the standard reference levels. The estimated Qp/Qs correlated mildly with BNP and ROM levels. The medication caused a significant decrease in BNP and ROM levels. The optimal decision, Qp/Qs greater than 1.5, estimated from receiver operator characteristic (ROC) curves was 371 U.CARR (58% sensitivity, 90% specificity) for ROMs, and that for BNP was 28.4 pg/ml (97% sensitivity 45% specificity). Direct comparison of ROMs and BNP did not show significantly different area under the curve values.　ROM levels can be a new biomarker for oxidative stress evaluation in children with CHD at almost the same sensitivity as the previous biomarkers, and an effective indicator when combined with other biomarkers and indicators

Sulfamethoxazole / Trimethoprim confer no change on the clinical course of Kawasaki disease

Kawasaki disease (KD) is one of the most common vasculitis in childhood, but its etiology is still unknown. We hypothesized that Sulfamethoxazole / Trimethoprim (S/T) would inhibit overproduction of cytokine due to heat shock protein produced by intestinal bacteria in patients with KD and improve the clinical course of KD indirectly. We have conducted a prospective study to assess the usefulness of S/T for KD. For patients with KD (S/T group, N=23), we use S/T in addition to the standard treatment in the guidelines such as intravenous immunoglobulin (IVIG) and moderate dose aspirin. The control group (non S/T group, N=32) is patients with KD treated with the standard treatment in the guidelines. The baseline characteristics did not demonstrate notable differences between the two groups. We compare duration of fever, rate of initial IVIG failure, the day of illness membranous desquamation appeared, and the occurrence of coronary artery lesion (CAL) between two groups. Membranous desquamation appeared rather earlier in S/T group than in non S/T group (11.4±3.0 day of illness vs 12.9±3.5 day of illness, P=0.078), but there was no statistically significant difference. Duration of fever (39±59 hours vs 42±57 hours, P=0.41), rate of initial IVIG failure (26% vs 31%, P=0.30), and number of CAL (8.6% vs 9.3%, P=0.87) were found no significant difference between two groups. These data indicated that the use of S/T in acute phase of KD didn\u27t improve any clinical course of KD

Long-term survival with RAS-associated autoimmune leukoproliferative disorder with somatic KRAS mutation:A case report

　RAS -associated autoimmune leukoproliferative disorder (RALD) is a recently reported rare nonmalignant autoimmune disorder. The characteristic clinical findings of RALD include monocytosis, leukocytosis, lymphoproliferation, and autoimmune phenomena. RALD is defined by somatic mutations in KRAS or NRAS . It is a new disease that was reported by Niemela and Takagi in 2011. The prognosis and incidence are currently unknown and the treatment strategy has not yet been established.　Here we describe the long-term survival of a patient with who displayed a somatic KRAS G12D mutation. His clinical features and labolatory data were overlapped with juvenile myelomonocytic leukemia and chronic myelomonocytic leukemia. Mercaptopurine hydrate, hydroxycarbamide and azacitizine were administered to control white blood cell count and improve clinical symptoms. He had a long survival time without hematopoietic stem cell transplantation

DNA Methylation of Colon Mucosa in Ulcerative Colitis Patients: Correlation with Inflammatory Status

Background: Although DNA methylation of colonic mucosa in ulcerative colitis (UC) has been suggested, the majority of published reports indicate the correlation between methylation of colon mucosa and occurrence of UC-related dysplasia or cancer without considering the mucosal inflammatory status. The aim of this study was to verify whether mucosal inflammation-specific DNA methylation occurs in the colon of UC. Methods: Of 15 gene loci initially screened, six loci (ABCB1, CDH1. ESR1, GDNF, HPP1, and MYOD1) methylated in colon mucosa of UC were analyzed according to inflammatory status using samples from 28 surgically resected UC patients. Results: Four of six regions (CDH1, GDNF, HPP1, and MYOD1) were more highly methylated in the active inflamed mucosa than in the quiescent mucosa in each UC patient (P = 0.003, 0.0002, 0.02, and 0.048, respectively). In addition, when the methylation status of all samples taken from examined patients was stratified according to inflammatory status, methylation of CDHI and GDNF loci was significantly higher in active inflamed mucosa than in quiescent mucosa (P = 0.045 and 0.002, respectively). Multiple linear regression analysis revealed that active inflammation was an independent factor of methylation for CDHI and GDNF. DNA methyltransferase 1 and 3b were highly expressed in colon epithelial cells with active mucosa] inflammation, suggesting their involvement in inflammation-dependent methylation. Conclusions: Methylation in colonic mucosa of UC was correlated with mucosal inflammatory status, suggesting the involvement of methylation due to chronic active inflammation in UC carcinogenesis

広域教育網構築に向けた2つの双方向衛星通信システムの接続

現在、日本国内で通信衛星を利用した双方向型(多地点型)画像・音声会議システムとしては、主に大学や国立教育研究機関を相互に結ぶSpace Collaboration System (SCS)と、国立大学医学部附属病院間を結ぶMedical Information Network by Communication Satellite for University Hospitals (MINCS-UH、愛称MINCS)が並存している。2システムを融合すれば、地上局数は180となり、全国の国立大学のほとんどをカバーでき、医療者の効率のよい再教育体制が構築できると共に、学際的研究をより発展させることが期待される。そこで、両システムを接続して双方向型の番組放映が可能であるか確認した。試験には、SCS地上固定局が3局、MINCSは講義校1局と質問校2局が参加した。その結果、システム間相互に信号をやり取りする部分でいくつかの不具合が発生したが、最終的には双方向での音声・画像による模擬的会議に成功した。これにより、両システムを接続して全国180の地上局を有する大規模衛星講義(会議)システムの有効性を確認できた。既存のシステムを活用し、さらに大規模な双方向型の通信システムを構築することは、教育機会の均等化、地域格差の是正、さらには災害対策としても有効であると考えられる。In Japan, two systems for two-way (multi-point) audiovisual satellite communication are currently in connecting mainly universities and national educational research organizations, and the "Medical Information Network by Communication Satellite for University Hospitals" (MINCS), which connects 30 of the 42 National University Hospitals. If these systems were connected, the number of earth stations would exceed 180, connecting most National Universities. This would facilitate the development of efficient ongoing education programs for the medical staff and allow the development of interdisciplinary study. Therefore, we attempted to connect the two systems in order to examine the possibility of two-way programming. Three MINCS earth stations and three SCS earth stations took part in the experiment. Teleconference in both directions was successful despite of some problems with signal exchange. The use of existing systems along with construction of a largerscale multi-point communication system would be useful in equalizing educational opportunities by correction of regional gaps. This system also has potential as a communication medium for use in disasters

コウガクブ トクベツケンキュウ ホウコクショ コウガク ニ オケル リッタイガゾウ カイセキシステム ノ カイハツ オウヨウ ニ カンスル ケンキュウ

The great development of computers and their rconnected terminals is producing the development of image technology and also the easy operation by networks for users. Given assistance of the special fiscal 1988 and 1989 budgets in the Faculty of Engineering, Tokyo Institute of Polytechnics, this project started in cooperation with the laboratories interested in the application of the image information. In order to fulfill graphic functions and image processor simultaneously by one system, which will be the most powerful research tool in the near future, IRIS 4D/50GT graphic computer and NEXUS image processor were purchased and connected with VME BUS so that a part of the multi-functional system was completed. As several analysis about the information of the three-dimensional image were conducted using the system, the abstract is reported